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Fokussierte Sonographie im Schockraum

Focused ultrasound in the emergency room

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Zusammenfassung

Ein Schockraum ohne Ultraschallgerät ist nicht mehr vorstellbar. Dies zeigt die große Bedeutung der Sonographie nicht nur bei Traumapatienten, sondern auch in der nichttraumatischen Schockraumversorgung. Nationale und internationale Leitlinien empfehlen den Einsatz bei einer Vielzahl von Erkrankungen, wie dem akuten Koronarsyndrom, dem infarktbedingten kardiogenen Schock, der Lungenarterienembolie und den akuten Aortenerkrankungen. Ein strukturiertes Vorgehen ist insbesondere im Schockraum aufgrund der dynamischen und zeitkritischen Situation notwendig. Anhand häufiger Leitsymptome, die zur Aufnahme in den Schockraum führen, werden Algorithmen aufgezeigt, die eine rasche Abarbeitung erlauben. Angelehnt an das etablierte ABCDE-Schema werden Einsatzmöglichkeiten der Sonographie vorgestellt.

Abstract

Ultrasound is an important tool in diagnosis and treatment of critically ill patients. For trauma patients the eFAST (extended focused assessment with sonography for trauma) algorithm is already implemented in the diagnostic pathway. However, critically ill patients without trauma also need a structured approach including an early focused ultrasonographic exam. National and international guidelines regarding critical illnesses such as acute coronary syndrome, cardiogenic shock complicating myocardial infarction, pulmonary embolism or acute aortic syndromes recommend the use of ultrasound. We present pathways how ultrasound can be used in the diagnostic approach of common symptoms such as dyspnea, shock and abdominal pain. Using the ABCDE approach this article shows how ultrasound can be incorporated into the diagnostic pathway.

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Literatur

  1. Berg KM, Soar J, Andersen LW et al (2020) Adult advanced life support: 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. https://doi.org/10.1161/CIR.0000000000000893

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bernhard M, Döll S, Hartwig T, Ramshorn-Zimmer A, Yahiaoui-Doktor M, Weidhase L, Petros S, Gries A (2018) Resuscitation room management of critically ill nontraumatic patients in a German emergency department (OBSERvE-study). Eur J Emerg Med 25:e9–e17

    Article  PubMed  Google Scholar 

  3. Bertil B, Pieper D (2014) Kurzversion der S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung. AWMF Regist. 012/019

    Google Scholar 

  4. Blanco P (2019) Ultrasound-guided peripheral venous cannulation in critically ill patients: a practical guideline. Ultrasound J 11:27

    Article  PubMed  PubMed Central  Google Scholar 

  5. Breitkreutz R, Campo delľ Orto M, Hamm C et al (2013) Does the integration of personalized ultrasound change patient management in critical care medicine? Observational trials. Emerg Med Int. https://doi.org/10.1155/2013/946059

    Article  PubMed  PubMed Central  Google Scholar 

  6. Busche C, Busch H‑J, Michels G (2018) Point-of-Care-Sonografie in der Notfall- und Intensivmedizin. Dtsch Med Wochenschr 143:161–164

    Article  PubMed  Google Scholar 

  7. Chelly J, Deye N, Guichard JP, Vodovar D, Vong L, Jochmans S, Thieulot-Rolin N, Sy O, Serbource-Goguel J, Vinsonneau C, Megarbane B, Vivien B, Tazarourte K, Monchi M (2016) The optic nerve sheath diameter as a useful tool for early prediction of outcome after cardiac arrest: a prospective pilot study. Resuscitation 103:7–13

    Article  PubMed  Google Scholar 

  8. Chenkin J, McCartney CJL, Jelic T et al (2015) Defining the learning curve of point-of-care ultrasound for confirming endotracheal tube placement by emergency physicians. Crit Ultrasound J. https://doi.org/10.1186/s13089-015-0031-7

    Article  PubMed  PubMed Central  Google Scholar 

  9. Chowdhury AR, Punj J, Pandey R, Darlong V, Sinha R, Bhoi D (2020) Ultrasound is a reliable and faster tool for confirmation of endotracheal intubation compared to chest auscultation and capnography when performed by novice anaesthesia residents—a prospective controlled clinical trial. Saudi J Anaesth 14:15–21

    Article  PubMed  PubMed Central  Google Scholar 

  10. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb SA, Beale RJ, Vincent JL, Moreno R, Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup (2013) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 41:580–637

    Article  PubMed  Google Scholar 

  11. Deutsche Gesellschaft für Unfallchirurgie (2019) Weißbuch Schwerverletztenversorgung. DGU, Berlin

    Google Scholar 

  12. Deutsche Gesellschaft für Kardiologie (2019) Deutsch-österreichische S3 Leitlinie „Infarktbedingter kardiogener Schock-Diagnose, Monitoring und Therapie“

    Google Scholar 

  13. Erbel R, Aboyans V, Boileau C et al (2014) 2014 ESC guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J 35:2873–2926. https://doi.org/10.1093/eurheartj/ehu281

    Article  PubMed  Google Scholar 

  14. Gottlieb M, Sundaram T, Holladay D, Nakitende D (2017) Ultrasound-guided peripheral intravenous line placement: a narrative review of evidence-based best practices. West J Emerg Med 18:1047–1054

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hempel D, Michels G (2019) Schock – eine Übersicht für die klinische Praxis. Dtsch Med Wochenschr 144(13):884–891

    Article  PubMed  Google Scholar 

  16. Hoffmann B, Gullett JP, Hill HF et al (2014) Bedside ultrasound of the neck confirms endotracheal tube position in emergency intubations. Ultraschall Med 35:451–458. https://doi.org/10.1055/s-0034-1366014

    Article  CAS  PubMed  Google Scholar 

  17. Ibanez B, James S, Agewall S et al (2018) 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 39:119–177. https://doi.org/10.1093/eurheartj/ehx393

    Article  PubMed  Google Scholar 

  18. Kirkpatrick AW, Sirois M, Laupland KB, Liu D, Rowan K, Ball CG, Hameed SM, Brown R, Simons R, Dulchavsky SA, Hamiilton DR, Nicolaou S (2004) Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the Extended Focused Assessment with Sonography for Trauma (EFAST). J Trauma 57:288–295

    Article  CAS  PubMed  Google Scholar 

  19. Konstantinides SV, Meyer G, Bueno H et al (2020) 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 41:543–603. https://doi.org/10.1093/eurheartj/ehz405

    Article  PubMed  Google Scholar 

  20. Kristensen MS, Teoh WH, Rudolph SS (2016) Ultrasonographic identification of the cricothyroid membrane: best evidence, techniques, and clinical impact. Br J Anaesth 117:i39–i48. https://doi.org/10.1093/bja/aew176

    Article  PubMed  Google Scholar 

  21. Kumle B, Merz S, Mittmann A et al (2019) Non-traumatic resuscitation room management: structure, organization, and initial measures. Notfall Rettungsmed 22:402–414. https://doi.org/10.1007/s10049-019-0613-1

    Article  Google Scholar 

  22. Lancellotti P, Price S, Edvardsen T et al (2015) The use of echocardiography in acute cardiovascular care: recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association. Eur Heart J Acute Cardiovasc Care 4:3–5

    Article  PubMed  Google Scholar 

  23. Michels G, Breitkreutz R, Pfister R (2014) Stellenwert der Lungensonographie in der Notfall- und Intensivmedizin. Dtsch Med Wochenschr 139:2301–2307

    Article  CAS  PubMed  Google Scholar 

  24. Michels G, Hempel D, Pfister R, Janssens U (2019) Emergency ultrasound and echocardiography in patients with infarct-related cardiogenic shock: a survey among members of the German Society of Medical Intensive Care and Emergency Medicine. Med Klin Intensivmed Notfmed 114:434–438. https://doi.org/10.1007/s00063-018-0431-0

    Article  CAS  PubMed  Google Scholar 

  25. Michels G, Pfister R, Hempel D (2018) Focused echocardiography in acute medicine. Med Klin Intensivmed Notfmed 113:625–630. https://doi.org/10.1007/s00063-018-0493-z

    Article  CAS  PubMed  Google Scholar 

  26. Michels G, Zinke H, Möckel M et al (2017) Recommendations for education in ultrasound in medical intensive care and emergency medicine: position paper of DGIIN, DEGUM and DGK. Med Klin Intensivmed Notfmed 112:314–319. https://doi.org/10.1007/s00063-017-0285-x

    Article  CAS  PubMed  Google Scholar 

  27. Park SC, Ryu JH, Yeom SR, Jeong JW, Cho SJ (2009) Confirmation of endotracheal intubation by combined ultrasonographic methods in the emergency department. Emerg Med Australas 21:293–297

    PubMed  Google Scholar 

  28. Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 37:2129–2200. https://doi.org/10.1093/eurheartj/ehw128

    Article  PubMed  Google Scholar 

  29. Roffi M, Patrono C, Collet JP et al (2016) 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 37:267–315. https://doi.org/10.1093/eurheartj/ehv320

    Article  CAS  PubMed  Google Scholar 

  30. Scholz KH, Andresen D, Böttiger BW, Busch HJ, Fischer M, Frey N, Kelm M, Kill C, Schieffer B, Storm C, Thiele H, Gräsner JT (2017) Qualitätsindikatoren und strukturelle Voraussetzungen für Cardiac-Arrest-Zentren – Deutscher Rat für Wiederbelebung/German Resuscitation Council. Med Klin Intensivmed Notfmed 112:459–461

    Article  CAS  PubMed  Google Scholar 

  31. Shahbazipar M, Seyedhosseini J, Vahidi E, Motahar Vahedi HS, Jahanshir A (2019) Accuracy of ultrasound exam performed by emergency medicine versus radiology residents in the diagnosis of acute appendicitis. Eur J Emerg Med 26:272–276

    Article  PubMed  Google Scholar 

  32. Soni NJ, Franco-Sadud R, Kobaidze K et al (2019) Recommendations on the use of ultrasound guidance for adult lumbar puncture: a position statement of the society of hospital medicine. J Hosp Med 14:591–601. https://doi.org/10.12788/jhm.3197

    Article  PubMed  PubMed Central  Google Scholar 

  33. Strøm JJ, Haugen PS, Hansen MP, Graumann O, Jensen MBB, Aakjær Andersen C (2020) Accuracy of lung ultrasonography in the hands of non-imaging specialists to diagnose and assess the severity of community-acquired pneumonia in adults: a systematic review. BMJ Open 10:e36067

    Article  PubMed  PubMed Central  Google Scholar 

  34. Thomas VK, Paul C, Rajeev PC, Palatty BU (2017) Reliability of ultrasonography in confirming endotracheal tube placement in an emergency setting. Indian J Crit Care Med 21:257–261

    Article  PubMed  PubMed Central  Google Scholar 

  35. Timmermann A, Russo SG, Eich C, Roessler M, Braun U, Rosenblatt WH, Quintel M (2007) The out-of-hospital esophageal and endobronchial intubations performed by emergency physicians. Anesth Analg 104:619–623

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Zentrale Notaufnahme, Asklepios Klinik Wandsbek, Alphonsstraße 14, 22043, Hamburg, Deutschland

    D. Hempel & S. Casu

  2. Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland

    G. Michels

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Correspondence to D. Hempel.

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Interessenkonflikt

D. Hempel und S. Casu geben an, dass kein Interessenkonflikt besteht. G. Michels erhielt gelegentlich Honorare für Vortragstätigkeiten von Pfizer, Novartis, Servier, Zoll, Getinge, Sedana Medical und Orion Pharma. Die Interessenkonflikte stehen in keinem Zusammenhang mit dem vorliegenden Manuskript.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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G. Michels, Eschweiler

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Hempel, D., Casu, S. & Michels, G. Fokussierte Sonographie im Schockraum. Med Klin Intensivmed Notfmed 116, 390–399 (2021). https://doi.org/10.1007/s00063-020-00768-y

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